Abstract
On November 23, 2023, the V International Forum of Experts on Menopausal Hormone Therapy (MHT) was held. The Expert Council’s working group included leading experts in the field of endocrine gynaecology and related areas from Azerbaijan, Armenia, Georgia, Kazakhstan, Moldova, Uzbekistan, and Ukraine.The Forum experts noted the importance of dialogue and understanding between doctor and patient, the need for interdisciplinary integration between doctors of those specialties that deal with women’s health issues. Close cooperation with related specialists who provide care to women is necessary, as they are often the ones who encounter the first manifestations of menopause in patients and can therefore refer them to an obstetrician-gynaecologist in a timely manner. The experts reviewed the issue of cardiovascular risk and MHT and determined the following benefit/risk ratio for the cardiovascular effects of MHT:• MHT is not recommended for women at high cardiovascular risk or with previous cardiovascular disease;• MHT may reduce the risk of CVD-related all-cause death in women < 60 years of age and with menopause of up to 10 years;• timely initiation of MHT (in women under 60 years of age or within 10 years of menopause) has the greatest cardiovascular health benefits.The forum updated the Algorithm for prescribing MHT in premature and early menopause and addressed the management of women with polycystic ovary syndrome in menopause. Since the majority of women with this syndrome are overweight and obese, they should use the most metabolically neutral drugs, i.e. those containing didrogesterone or progesterone, for MHT. MHT with didrogesterone has a favourable safety profile in relation to the most common risks of MHT: does not increase the risk of breast cancer and venous thromboembolism, has a favourable safety profile with respect to the endometrium, and does not affect metabolism.